Session Spotlight: Process Evaluation for Small to Mid-Sized Pharmaceutical Companies

Gross-to-Net calculations are not just for big pharma. While the larger organizations have a variety of people across several functions involved in the process, smaller companies make do with far fewer resources. In this session, leaders in smaller pharmaceutical companies address unique challenges inherent to companies their size and much more. 

Session: Process Evaluation for Small to Mid-Sized Pharmaceutical Companies

Speakers:
Paul Troiano, Senior Director, Commercial Finance, OPTIMER PHARMACEUTICALS
 Alberto Bonilla, Director, Commercial Finance, WARNER CHILCOTT

It’s not a new story that smaller pharmaceutical companies often have a more difficult time than their larger counterparts. One person might have the same function as four different people at a larger company. This session discusses some of the additional challenges such as who should be involved in estimating GTN and to what capacity, and how professionals devise estimates when the company lacks a large number of products to draw analogies from and how do they estimate returns.

Want to learn more? Download our brochure.

The Gross-to-Net Accounting Forum takes place June 17-18 in Boston, MA. As a reader of this blog you'll receive 15% off the standard rate by using code XP1811BLOG when you register. We look forward to seeing you this June!

Session Spotlight: Screenings, Biomarkers & Diagnostic Testing to Manage Outcomes and Costs

Advances in our understanding of the genetic mutations and alterations and resultant expression are leading to the identification of more and more biomarkers to help direct patient management. Biomarker development and applications are being seen in early detection, prognosis, toxicity profiling, predictive, effective monitoring, follow up, etc.

IIR’s Collaborative Summit for Oncology brings together a multi-stakeholder view of the current state of biomarker use and how the use of these applications will lead to less toxic care. They will also discuss insights into what you can expect to see in the next 3-5 years to increase positive outcomes and manage costs of oncology.

SESSION SPOTLIGHT:  The Use of Screenings, Biomarkers & Diagnostic Testing to Increase Positive Outcomes and Manage Cost of Oncology

Moderator: Paul Howard, Director and Senior Fellow Center for Medical Progress, Manhattan Institute for Policy Research

Panelists:

• William T. McGivney, PhD, Former NCCN CEO, McGivney Global Advisors
• Oscar Puig, Biomarker Lead in Oncology, Translational Clinical Research Center, Roche
• Maurie Markman, MD, Senior Vice President, Clinical Affairs, Cancer Treatment Centers of America

To learn more, download our brochure.

As a reader of the healthcare insights blog, you can use priority code XP1814BLOG to receive 15% off of the standard rate to register. If you have any questions or need any further information, feel free to email kdevery@iirusa.com or visit the webpage.

We look forward to seeing you in June!

Best,
Oncology Management Team

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Session Spotlight: Account for the Government Pricing and Contracting Impact on Gross-to-Net Calculations

As the largest healthcare provider to the American population, the US government has a significant impact on pharmaceutical company financials. With Medicaid expansion continuing into 2014, this impact is only going to grow. Manufacturers must calculate prices for each product, along with the reimbursement rate on each prescription. These rebates make GTN calculations a time-consuming endeavor for finance divisions, so what is the best way to proceed?

Session: Account for the Government Pricing and Contracting Impact on Gross-to-Net Calculations

Speaker: Jennifer Norton, Senior Director, Pricing & Contract Administration - Managed Markets, Vertex Pharmaceuticals , Inc.

The US Government is the largest healthcare provider to the American population and therefore has a significant impact on pharmaceutical company financials. Each day we hear of another state’s decision whether or not to expand Medicaid, as is their option. As some states decide to expand, the government’s impact on company financials will only continue to grow. Government reimbursement and rebates have a direct impact on GTN calculations. In this session, executives from Vertex Pharmaceuticals will discuss how government pricing and contracting affects GTN and the operational challenges that arise that affect that calculation.

Want to learn more? Download our brochure.

The Gross-to-Net Accounting Forum takes place June 17-18 in Boston, MA. As a reader of this blog you'll receive 15% off the standard rate by using code XP1811BLOG when you register. We look forward to seeing you this June!

Leading the way for Medicaid

Today's guest post comes from Michael DeVincent, VP of Sales, MedSolutions . Follow them @Medsolutions1

In 2006, MedSolutions implemented Medicaid’s first radiology benefits management (RBM) program. Today, we’re the leader in Medicaid experience, offering not just RBM but a wide range of medical cost management programs addressing everything from radiation therapy to spine surgery.

Our company partners with a number of state and commercially managed Medicaid payers, serving more than 11 million Medicaid beneficiaries. We fully understand the complex issues within Medicaid, including shifting in aid categories and dual eligibility, as well as the opportunity for fraud and abuse that compromises patient safety and drives up costs.

At MedSolutions, our belief is that better healthcare is inherently less expensive. That ability to improve care for patients while lowering costs will only become more important as Medicaid enrollment expands under the Patient Protection and Affordable Care Act. According to the Kaiser Family Foundation, the expansion could reach an estimated 16 million uninsured people by 2019. What’s more, two-thirds of Medicaid enrollees now receive most or all of their benefits in managed care, and many states are expanding their use of managed care to additional geographic areas and Medicaid populations.

With the depth of our Medicaid experience, we’re uniquely positioned to meet this growing need, and our results speak for themselves. Recent Medicaid customers have seen a reduction in PMPM imaging costs of 15 to 26 percent, all while improving patient care. In one state Medicaid population, prior to the implementation of our program, dramatic over-testing put patients at risk. For example, 170 Medicaid patients received more than 11,800 imaging scans in only two years – that’s the equivalent of 70 scans per person! High-risk groups such as pregnant women, where radiation exposure may harm the mother and baby, are especially vulnerable. In one case, a Medicaid patient received 22 CT scans during her pregnancy at tremendous risk to the unborn child. Our program put an end to this dangerous and expensive level of testing, applying evidence-based guidelines to ensure patients get the right test at the right time for their diagnostic needs.

We’re excited about the many programs we offer that can improve the care Medicaid patients receive and simultaneously generate significant savings. We hope you’ll stop by booth #18 to learn more next week at the Medicaid Managed Care Congress 2013.

It's not too late to register for the 21st Annual Medicaid Managed Care Congress! To learn more, download our brochure. We hope to see you next week in Baltimore, MD!

Hurry! There is still time left to register for the 21st Annual Medicaid Managed Care Congress!

Are you ready? The 21st Annual Medicaid Managed Care Congress has been the number one meeting place to collaborate with state officials and health plan executives to drive next generation Medicaid managed care for our business. Join more than 300 attendees within the Medicaid managed care space to discuss exchanges, duals and Medicaid expansion, and get real time updates on the most important elements of healthcare reform. You will be sure to learn how to cost efficiently provide better care to members without increasing expenditures.

•  More than 30 presentations from all of the big players including Wellpoint, AmeriHealth Mercy, Amerigroup as well as smaller regional plans like Network Health, Neighborhood Health Plan of Rhode Island and BMC HealthNet Plan.

• Preconference summit options focused on health insurance exchanges, predictive modeling, Medicaid managed care for pharmaceutical executives and the ever-popular Medicaid Managed Care 101.

• Three newly aligned tracks bringing you everything from financial and administrative considerations that will decrease overhead, to engagement, enrollment, and retention in order to recruit and retain members, to best practices for complex care management.

It’s not too late to register! As a reader of the healthcare insights blog, you can use priority code XP1826BLOG to receive 15% off of the standard rate.

To learn more about out the 21st Annual Medicaid Managed Care event, download the brochure. If you have any questions or need any further information, feel free to email kdevery@iirusa.com or visit the webpage.We look forward to seeing you next week in Baltimore!

Cheers,

The Medicaid Managed Care Congress

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Session Spotlight: Case Study: Using State Invoices to Validate CMS URAs

Manufacturers can use URAs reported on state invoices to crowdsource the CMS calculated URA. Without URA reports available for manufacturers, state data allows manufacturers to assure rebate software and product master settings align to the CMS DDR methodology for URA calculation. But what are the best ways to validate CMS URAs?

Session:  Case Study: Using State Invoices to Validate CMS URAs

Speaker: David Buckley, GlaxoSmithKline

This case study by GlaxoSmithKline provides pointers on how to aggregate the state reported data to eliminate researching one-off URA keying error situations, discusses recommending systematic validation to enable verification of manufacturer rebate systems and receive lessons learned about timing of the review and tips on communicating with internal and external stakeholders.

Want to learn more? Download our brochure.

The 18th Annual Medicaid Drug Rebate Program takes place September 9-11 in Chicago, IL. To learn more visit our webpage. As a reader of the healthcare insights blog, you receive an exclusive discount of 15% off of the standard price by using priority code XP1858BLOG to register. We look forward to seeing you this fall!

Highlights from the MMCC Podcast featuring Cindy Pigg

Last week, we posted our exclusive podcast on Medicaid expansion and health insurance exchanges with Cindy Pigg, Senior Vice President of Pharmacy at Magellan Medicaid Administration.

Highlights from the podcast include:

Q: How does the Medicaid population change in light of healthcare reform?
Cindy: Oh wow. Exciting times here. People ask: “Why in the world did you come into the Medicaid space?" and I say, “Because that is where the action is going to be in the foreseeable future.”


Q: More specifically, how will exchanges impact Medicaid? 
Cindy: With these exchanges, this continual coverage will give us the ability to really focus on long-term health outcomes.

Download the complete podcast!

Cindy Pigg is a speaker at the 21st Annual Medicaid Managed Care Congress, taking place on May 20 – 22 in Baltimore.

Want to learn more? Download our brochure.

As a member of the healthcare insights blog, you receive an exclusive discount of 25% off of the standard price by using priority code XP1858BLOG to register. Do you have any questions about the event? Feel free to contact Kate Devery at kdevery@iirusa.com or visit the webpage.